Kim YS, Lee C, Oh J, Nam S, Doo AR. Hemodynamic instability following intravenous dexmedetomidine infusion for sedation under brachial plexus block: Two case reports. World J Clin Cases 2023; 11(30): 7469-7474 [PMID: 37969436 DOI: 10.12998/wjcc.v11.i30.7469]
Corresponding Author of This Article
A Ram Doo, MD, PhD, Assistant Professor, Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, South Korea. ruiwin3518@gmail.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 26, 2023; 11(30): 7469-7474 Published online Oct 26, 2023. doi: 10.12998/wjcc.v11.i30.7469
Hemodynamic instability following intravenous dexmedetomidine infusion for sedation under brachial plexus block: Two case reports
Ye Sull Kim, Chanhong Lee, Jeongmin Oh, Seonhwa Nam, A Ram Doo
Ye Sull Kim, Chanhong Lee, Jeongmin Oh, Seonhwa Nam, Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital, Jeonju 54907, South Korea
A Ram Doo, Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, South Korea
A Ram Doo, Department of Anesthesiology and Pain Medicine, Research Institute of Clinical Medicine-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, South Korea
Author contributions: Kim YS contributed to manuscript writing and editing; Lee C contributed to investigation and data analysis; Oh J and Nam S contributed to data collection; Doo AR contributed to conceptualization and supervision; and all authors have read and approved the final manuscript.
Supported bythe Fund of Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Republic of Korea.
Informed consent statement: Written informed consent was obtained from the patients for publication of this case report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: A Ram Doo, MD, PhD, Assistant Professor, Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, South Korea. ruiwin3518@gmail.com
Received: August 3, 2023 Peer-review started: August 3, 2023 First decision: September 4, 2023 Revised: September 13, 2023 Accepted: September 28, 2023 Article in press: September 28, 2023 Published online: October 26, 2023 Processing time: 83 Days and 3.5 Hours
Abstract
BACKGROUND
Dexmedetomidine (DMED) is frequently used as a sedative in several medical fields. The benefits of DMED include enhanced quality of regional anesthesia, prolonged analgesia, and postoperative opioid-sparing when administered intravenously or perineurally in combination with regional anesthesia. Severe hemodynamic complications, such as profound bradycardia and hypotension, can occur after DMED administration in critically ill patients or overdosage; however, there are few reports of complications with DMED administration following brachial plexus block (BPB).
CASE SUMMARY
We present two cases of hemodynamic instability that occurred following the initial loading of DMED under supraclavicular BPB. A healthy 29-year-old man without any medical history showed profound bradycardia after receiving a loading dose of DMED 0.9 μg/kg for 9 min. DMED administration was promptly stopped, and after receiving a second dose of atropine, the heart rate recovered. A 62-year-old woman with a history of cardiomyopathy became hypotensive abruptly, requiring the administration of inotrope and vasopressors after receiving a reduced loading dose of 0.5 μg/kg for 10 min. Half of the recommended loading dose of DMED was administered due to the underlying heart dysfunction. Decreased blood pressure was maintained despite the intravenous administration of ephedrine. With continuous infusion of dopamine and norepinephrine, the vital signs were maintained within normal ranges. Inotropic and vasopressor support was required for over 6 h after the initial loading dose of DMED.
CONCLUSION
DMED administration following BPB could trigger hemodynamic instability in patients with decreased cardiac function as well as in healthy individuals.
Core Tip: Although severe, there are few reports of complications with dexmedetomidine (DMED) administration following brachial plexus block. Profound bradycardia can occur even in healthy individuals with DMED administration following brachial plexus block. It can trigger refractory hypotension without apparent bradycardia in patients with decreased cardiac function. Therefore, clinicians must be aware of these potential yet critical consequences while selecting sedatives.
